Aim: Oral candidiasis in immunocompromised patients undergoing hematopoietic stem cell transplantation (HSCT) is a common fungal infection and carries a risk for systemic candidemia, that can be fatal. Optimal prevention of fungal infection is based on the balance between drug efficacy, patient's compliance and drug resistance. These three factors were investigated in order to develop an effective preventive therapy. Methods: The study was a randomized, controlled, prospective, longitudinal, double-blind-evaluated, consisting of two arms: (A) chlorhexidine (CHX) 0.2% mouth-rinse x4/d, (B) CHX 0.2% mouth-rinse x2/d combined with amphoteracin B (AMB) lozenges x4/d. The patients were monitored clinically and by laboratory analysis from day -7 before the HSCT until one month after release from the hospital. This protocol reflects the benefit in each of the three aspects of the optimal preventive triangle. Results: No clinical signs of oral candidiasis were observed in any of the 20 patients. All patients had fever and neutropenia which was treated with a combination of antibiotics, and 12/20 patients received systemic anti-fungal therapy. The duration of antibiotic treatment was longer in group A relative to group B (62.5% vs. 44% of hospitalization duration) while the difference in the systemic anti-fungal treatment was non-significant. Oral mucositis in group A manifested later and for a shorter duration in comparison with group B. The rate of AMB-induced-nausea was much higher (5/10 patients) in comparison to CHX-induced-taste disorder (1/20 patients). Conclusion: It is suggested that CHX is effective as a single topical anti-fungal prophylaxis in patients undergoing HSCT. Thus, the balance between effective anti-fungal prevention, drug-related-side effects, and fungal resistance was improved. This may be beneficial to other immunocompromised patients.

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